The role of infant feeding practices in the explanation for ethnic differences in infant growth: the Amsterdam Born Children and their Development study

Abstract

Rapid early growth in infants may influence overweight and CVD in later life. Both rapid growth and these disease outcomes disproportionately affect some ethnic minorities. We determined ethnic differences in growth rate (D standard deviation scores, DSDS) during the first 6 months of life and assessed the explanatory role of infant feeding. Data were derived from a multiethnic cohort for the Amsterdam Born Children and their Development study (The Netherlands). Growth data (weight and length) of 2998 term-born singleton infants with no fetal growth restriction were available for five ethnic populations: Dutch (n 1619), African descent (n 174), Turkish (n 167), Moroccan (n 232) and other non-Dutch (n 806). DSDS for weight, length and weight-for-length between 4 weeks and 6 months were defined using internal references. Infant feeding pattern (breast-feeding duration, introduction of formula feeding and complementary feeding) in relation to ethnic differences in growth rate was examined by multivariate linear regression. Results showed that the growth rate was higher in almost all ethnic minorities, with b between 0·07 and 0·41 for DSDS weight and between 0·12 and 0·42 for DSDS length, compared with ethnic Dutch infants. DSDS weight-for-length was similar across groups, except for Moroccan infants (b 0·25, P,0·05) after correction for confounders. In general, exclusive breast-feeding for 4 months was associated with slower growth for all three growth measures. Feeding factors explained, to a small degree, the higher weight and length gain in African descent infants, but not the higher DSDS weight-for-length in the Moroccan population. More research is needed to elucidate the underlying mechanisms of the high infant growth rate in Turkish and Moroccan infants.

Declining and stabilising trends in prevalence of overweight and obesity in Dutch, Turkish, Moroccan and South Asian children 3-16 years of age between 1999 and 2011 in the Netherlands

“…The reason that Turkish and Moroccan children gain more weight during infancy is unknown. Even though infant feeding practices differed between the ethnic groups studied, this was not directly associated with the excess weight gain 12. Such single factors may not sufficiently explain the ethnic disparities in childhood overweight and obesity.…”

Connecting the Dots in Childhood Obesity Disparities: a Review of Growth Patterns from Birth to Pre-Adolescence

“…Thirteen studies examined growth by modeling the difference in weight, length, or relative weight between two time points as a function of SES, race/ethnicity, or other predictors of growth [25-36]. These measures are indicated as Δoutcome (age range) [e.g., Δweight z-score (birth to 12m) ] in Tables 1-2 and Appendix Tables S2-3.…”

“…From birth to 12 months, minority race/ethnicity and lower SES was typically associated with faster weight gain (Table 1; Appendix Table S2) indicated by more positive weight differences [25, 30, 34-36], higher risk of rapid growth [28, 33], or diminishment of lower weight in lower SES or minorities with increasing age [45]. However, results were mixed [29, 36, 39, 42, 49], especially with regard to specific race/ethnic groups [28, 30, 45].…”

“…From birth to 12 months, minority race/ethnicity was associated with faster linear growth [25, 39, 42, 44, 45], with heterogeneity across specific race/ethnic group [45]. Evidence was equivocal for low SES, which was associated with faster [47] or similar [29, 41] linear growth in the first year (Appendix Table S3).…”

Exclusively breastfed overweight infants are at the same risk of childhood overweight as formula fed overweight infants

“…Data about feeding type were derived from Child Health Care (assessed at an average of eight time points in the first 2 years) and the ABCD study's infant questionnaire 16 17. Information about the duration of breast feeding (weeks), the age at the introduction of formula feeding (FF) (weeks) and of additional feeding (weeks) were used to categorise feeding type into EBF, FF and MF.…”